The cognitive approach believes that mental illness stems from faulty thinking, and cognitive behavioural therapy (CBT) is an umbrella term for many different therapies that recognize the importance of the link between our thoughts (cognition) and feelings, and how they interact and influence our behaviour in certain situations.
One of the earliest forms of CBT was developed by Aaron Beck in the late 1960’s. He devised the term ‘automatic thoughts’ for those emotion-filled thoughts that pop into our minds automatically when we find ourselves in certain situations, because the way we react is often pre-determined by how we feel about the situation.
Many automatic thoughts develop in childhood, and whilst some are positive and helpful, others are negative and harmful, and it is these that can cause anxiety or depression in the individual, and prejudice their chances of long-term happiness and success.
Unfortunately, people aren’t always fully aware of these thought patterns, and CBT can help them identify and monitor what triggers them. This in turn enables them to step outside of their automatic thoughts; to test them out, see things from a fresh perspective, and develop alternative ways of thinking and behaving.
Key elements of CBT
CBT differs from other types of psychotherapy because it’s:
Pragmatic: it is problem-focused and practical.
Highly structured: the therapist helps the client to produce an action plan and set goals, rather than allowing them to talk freely about their life.
Focused on current problems: it’s concerned with now, rather than attempting to resolve past issues.
Collaborative: the therapist works with the client to find solutions, rather than telling them what to do.
Short-term: most problems are treated within 5 to 25 sessions.
Who can it help?
CBT can be a very useful tool, either alone or in combination with other therapies, in treating a range of mental health disorders such as depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). It can also be an effective way to help individuals manage stressful situations in their life; from sleeping difficulties or relationship problems, to drug abuse or anger management issues.
How successful is CBT?
Research shows that overall the evidence that CBT is effective is enormous, especially for treating anxiety disorders. In the UK it has been adopted as a first-line intervention for mental health disorders due to its cost-effectiveness. Find further information here:
The first CBT session
The therapist will typically spend the first session asking the client questions and gathering information to determine the best course of action, which at the same time, affords the client the opportunity to satisfy themselves that he or she will be a good ‘fit’ for them. CBT favours a more equal relationship between client and therapist than other forms of psychotherapy, so having a good working relationship is key to getting the most out of the process. If the client isn’t comfortable with their therapist, they should try someone else.
Step by step
The CBT process typically follows these steps:
Identify the problems: the client and therapist will spend time deciding what the problems are, and what the client hopes to achieve through therapy. These problems and goals will then become the basis for planning the content of future sessions.
Identify the thoughts and emotions behind these problems: the therapist will guide the client to explore and discuss their thoughts and beliefs about themselves, other people, and events, and how that makes them feel.
Identify negative or inaccurate thinking: the therapist will help the client to analyse and question their physical, emotional and behavioural responses in different situations, to work out if they’re unrealistic or unhelpful. Eventually the client will be able to distinguish between what is fact, and what is based on inaccurate perception.
Homework: the therapist may ask the client to keep a diary for writing down their thought and behaviour patterns. Working on homework assignments between sessions in this way, is a vital part of the process. What this may involve will vary, and later on might consist of exercises to cope with problem situations of a particular kind.
Reshape negative or inaccurate thinking the therapist will encourage the client to try out new interpretations of situations, and apply alternative ways of thinking in their daily lives. One of the biggest benefits of CBT is that after their course has finished, clients can continue to apply the principles they have learned. With practice, helpful thinking and behaviour patterns will become a habit, making it less likely that negative or inaccurate thinking will return.
In general, there’s little risk associated with CBT, but clients may feel emotionally uncomfortable at times. A skilled therapist will not ask them to do things they don’t want to do, but confronting fears and anxieties can be very difficult, and clients may get upset or feel angry during a challenging session.
Exposure therapy is a form of CBT particularly useful for people with phobias or obsessive-compulsive disorder. In these cases, talking about the situation is not enough, and clients may need to learn to face their fears in a methodical and structured way through exposure therapy. This involves gradually introducing them to items or situations that cause anxiety, but anxiety that they are able to tolerate. Together with the therapist, they will set weekly targets that are achievable, but will cause anxiety, such as, in the case of someone with a fear of spiders, looking at photos of spiders, then videos, then gradually being introduced to a live specimen. This may seem intolerable to most people at the outset… but with hard work and determination, they can learn the skills required to tolerate, and eventually overcome, their fear.
Choosing a therapist
When choosing a therapist, clients should check they are qualified and licence to practice, and that they have expertise and experience treating their particular symptoms or area of concern, such as depression or PTSD.
Group and on-line sessions
CBT is usually a one-to-one therapy, but it can also work for groups or families because many people benefit from sharing their difficulties with others who may have personal experience of a similar problem. Also, by seeing several people at once, service-providers can offer help to more people at the same time, so people get help sooner. For those who are unable to access face to face sessions, or prefer to use a computer rather than talk directly to a therapist, on-line resources are available, making CBT accessible to anyone with an internet connection.